Oral Medicine Flashcards
(134 cards)
1
Q
What is the location of white sponge naevus? (4)
A
- oral
- nasal
- oesophageal
- ano genital mucosa
2
Q
What is the location of lichen planus? (6)
A
- cheeks
- tongue
- gingivae
- lips
- FOM
- palate
3
Q
What analgesics/mouthwashes are used to treat lichen planus? (2)
A
- benztdamine 0.15% mouthwash or oro mucosal spray
- chlorohexidine mouthwash
4
Q
What topical steroids do you use to treat lichen plans? (3)
A
- betamethasone soluble tablets 500 micrograms
- clenil modulate 50 micrograms
- hydrocortisone oromucosal tablets
5
Q
What HPVs are associated with oropharyngeal cancer?
A
HPV 16 and 18
6
Q
How does HPV take over the cell? (3)
A
- viral E6 protein can bind to and inactivate p53
- p53 repairs DNA damage or pushed cell into apoptosis
- if p53 is inactivated, virus can take over the cell
7
Q
What enzyme does the HPV viral E6 protein activate? What does this do?
A
The HPV viral E6 protein also activates telomerase. Activating this enzyme keeps the cell dividing with abnormal DNA grt cancer
8
Q
What are the effects of chewing betel nut? (4)
A
- alters mood
- expels parasitic worms from the body
- parasympathetic properties produce euphoria and counteract fatigue
- suppresses appetite
9
Q
What is the pathogenesis of betel quid? (4)
A
- arecoline an alkaloid in the nut has been shown to stimulate collagen synthesis by 170%
- tannins present in the nut increase the resistance to collagen degradation
- DNA damage
- lime can release reactive species from extracts of betel nut
10
Q
What risks are associated with chewing betel quid? (5)
A
- increases risk of squamous cell carcinoma
- oral submucosa fibrosis
- fibrosis of the oesophagus
- periodontitis
- atherosclerosis and hypertension via endothelial cell damage
11
Q
What are the signs and symptoms of chewing betel nut? (4)
A
- mucosal petechiae
- burning sensation when eating
- restriction in mouth opening
- staining and wear of teeth
12
Q
What is the management for pts chewing betel nut? (4)
A
- habit intervention
- regular review to detect dysplasia and malignancy
- muscle stretching exercises
- nutritional supplementation
13
Q
What are the risks of using cigarettes? (4)
A
- increased levels of acetaldehyde from eliquids with flavourings
- increased BP, heart rate, coronary artery thickness
- traces of tobacco nitrosamines
- spate of deaths from vaping
14
Q
What are the sources of acetaldehyde? (4)
A
- alcohol metabolism
- tobacco smoke
- bacteria associated with poor OH
- food
15
Q
Why was the alcohol limit lower for women?
A
Because womens bodies have a higher proportion of body fat and less water than men. The conc of alcohol in body water is higher
16
Q
What are the classifications of TMD syndromes? (4)
A
- pain dysfunction syndrome
- trauma and dislocation
- infection
- neoplasia
17
Q
What soft tissues are involved in TMJ anatomy? (5)
A
- bilaminar zone
- intra articular disc
- lateral pterygoid
- joint capsule
- ligaments
18
Q
What should you look for in an intra oral soft tissue examination for TMD? (2)
A
- ridging buccal mucosa at level of occlusal plane
- scalloping of borders of tongue
19
Q
What are the types of TMD diagnosis? (2)
A
- pain related TMDs
- intra articular TMDs
20
Q
Name 3 pain related TMDs?
A
- myalgia
- arthralgia
- headache related to TMD
21
Q
How do we diagnose TMD arthralgia? (3)
A
- confirmation of pain location in area of TMJ
- familiar pain on palpation of lateral pole
- maximum unassisted or assisted opening, right or left lateral or protrusive movements
22
Q
Types of intra articular TMDs? (6)
A
- disc displacement with reduction
- disc displacement with reduction with intermittent locking
- disc displacement with reduction with limited opening
- disc displacement without reduction with limited opening
- disc displacement without reduction without limited opening
- degenerative joint disease
- subluxation
23
Q
What is TMD degenerative joint disease?
A
A degenerative disorder involving the joint characterised by deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence
24
Q
What is TMD subluxation?
A
A hyper mobility disorder involving the disc condyle complex and the articular eminence. Open mouth disc condyle complex is anterior to the articular eminence and is unable to return to a normal closed position without manipulative procedures
25
What is the difference between subluxation and lunation?
```
Subluxation= if patient can manoeuvre the joint into position
Luxation= if assistance of clinician is required
```
26
What is the history of TMD subluxation? (2)
- in the last 30 days jaw locking or catching in a wide open mouth position, even for a moment, so could not close from the wide open mouth position
- inability to close the mouth from a wide open position without a manipulative procedure
27
What are the red flags for TMD? (5)
- chronic TMD symptoms lasting for more than 3 months
- persistent or worsening symptoms despite primary care treatment
- an uncertain diagnosis
- marked psychological distress associated with symptoms and/or occlusal preoccupation
- unexplained persistent pain or chronic widespread pain
28
What are the TMD red flags for truisms? (6)
- opening less than 15mm
- progressively worsening truisms
- absence of history of clicking
- pain of non myofascial origin
- swollen lymph glands
- suspicious intra oral soft tissue lesion
29
What is the conservative management for TMD? (6)
- modify diet
- avoid wide mouth opening
- regular application of heat
- regular application of cold pack
- jaw exercises
- NSAIDs
30
What is osteomyelitis?
Inflammation of the medullary portion of the jaw bone which extends to involve the periosteum of the effected area
31
How does osteomyelitis occur?
Osteomyelitis becomes established in the calcified portion of bone when pus in the medullary cavity or beneath the periosteum obstructs the blood supply. The infected bone becomes necrotic once schema sets it
32
What is acute osteomyelitis?
A polymicrobial disease with streptococci, bactericides, peptostreptococci and other organisms involved
33
What are the mechanisms of infection for osteomyelitis? (4)
- spread from odontogenic focus
- trauma
- surgery
- spread from non odontogenic infection
34
What are the local causes of osteomyelitis? (4)
- radiotherapy
- osteoporosis
- pagets
- fibrous dysplasia
35
What are the systemic causes of osteomyelitis? (4)
- diabetes
- malnutrition
- alcoholism
- sickle cell disease
36
Give 4 examples of non suppurative osteomyelitis?
- chronic sclerosing
- garres sclerosing
- actinomycotic
- osteoradionecrosis
37
What is the presentation of acute suppurative osteomyelitis? (4)
- local pain
- fever
- lymphadenopathy
- trismus
38
What is the presentation of chronic osteomyelitis? (4)
- swelling
- pain
- purulence
- intraoral or extraoral draining fistula
39
What is the treatment for osteomyelitis? (4)
- imaging of the region
- empirical administration of antibiotics
- drain and irrigate the area
- removal of loose teeth and sequestra
40
What is garres osteomyelitis?
Chronic osteomyelitis with subperiosteal new bone formation resulting from periosteal reaction to chronic inflammatory/infectious stimulation
41
What are the local risk factors for MRONJ? (3)
- trauma (XLA, implants periradicular surgery)
- local anatomy (poor fit, tori, mylohyoid ridge)
- concomitant local disease (periodontal, poor OH)
42
What are the systemic risk factors for BRONJ? (4)
- age
- renal dialysis
- diabetes
- steroids
43
What are the presenting signs and symptoms of BRONJ? (4)
- area of necrotic exposed bone
- internal or external discharging fistulas
- pain
- loose teeth
44
What are the higher risk patient for BRONJ SDCEP guidelines? (4)
- previous diagnosis of BONJ
- taking bisphosphonates as part of the malignant condition
- other non malignant conditions of the bone e.g. pagets disease
- under the care of a specialist for a malignant condition e.g osteogenesis imperfecta
45
What is the treatment of established lesions? (5)
- conservative management best, irrigation, antibiotics
- do not curette
- remove small/loose sequestra
- hyperbaric oxygen may have no effect
- stop bisphosphonates
46
What is denosumab? (3)
- human monoclonal antibody that inhibits osteoclast function
- acts by inhibiting RANKL a protein that acts as the primary signal for bone removal
- mimics the function of endogenous osteoprotegrin
47
What newer drugs cause MRONJ? (3)
- everolimus
- raloxifine
- teriparatide
48
What are the types of herpes viral infection? (5)
- herpes simplex type 1 and 2
- varicella voster
- epstein barr virus
- cytomeglavirus
- human herpes virus 8
49
What are the types of viral infection? (5)
- herpes viruses
- group A coxsackie viruses
- paramyxovirus
- human papilloma viruses
- retroviruses
50
What is the analgesia treatment for primary herpetic gingivostomatits? (2)
Systemic- paracetamol
| Topical- benzydamine hydrochloride 0.15%
51
What is the antimicrobial treatment for primary herpetic gingivostomatitis? (2)
- chlorohexidine gluconate 0.2% mouthwash
| - hydrogen peroxide mouthwash 6%
52
What are the symptoms of herpes zoster (shingles)? (3)
- pain
- rash
- ophthalmic division
53
What is acyclovir?
A DNA polymerase inhibitor
54
What is acyclovir active against? (3)
- HSV
- VZV
- CMV
55
What is acyclovir broken down into?
Acyclovir monophosphate then acyclovir triphosphate
56
What does acyclovir triphosphate do? (3)
- inhibits herpes virus DNA polymerase competitively
- gets incorporated in viral DNA and stops lengthening of DNA strands
- the terminated DNA inhibits DNA polymerase irreversible
57
What are the contraindications of acyclovir? (2)
- hypersensitivity reactions
| - pregnancy
58
What are the side effects of acyclovir? (4)
- GI upset
- rash
- headache
- vertigo
59
What are the interactions of acyclovir? (4)
- sodium valproate
- lithium
- pethidine
- ciclosporin
60
What are the specific mechanisms of viral resistance against acyclovir? (3)
- loss of viral thymidine kinase activity
- mutations in thymidine kinase gene make it unable to perform 1st phosphorylation
- expression of altered DNA polymerase activity
61
What are the alternatives to acyclovir? (3)
- valaciclovir
- penciclovir
- famciclovir
62
What coxsackie viruses can you get? (3)
- herpangia
- hand foot and mouth disease
- acute lymphonodular pharyngitis
63
What are the symptoms of herpangia? (3)
- systemic
- sore throat
- oropharyngeal lesions
64
Name 2 other viral infections
Measles- morbillivirus
| Mumps- paramyxovirus
65
What are the types of human papilloma virus? (4)
- squamous cell papilloma
- verruca vulgaris
- condyloma acuminatum
- focal epithelial hyperplasia
66
What types of viral infection are strongly associated with HIV? (4)
- candidiasis
- kaposis sarcoma
- non hodgkins lymphoma
- periodontal disease
67
What does anti retroviral therapy do?
Significantly lowers the prevalence of leukoplakia and necrotising periodontal disease
68
What are the types of candida bacteria? (4)
- c.albicans
- c.tropicalis
- c.glabarata
- c.parapsilosis
69
What are the classifications of candidosis? (4)
- acute pseudomembranous
- acute erythematous
- chronic erythematous
- chronic hyperplastic
70
What are the topical intra oral treatments for candidosis? (2)
- miconazole oromucosal gel 20mg/g
| - nystatin suspension 100,000 units/ml
71
What are the topical extra oral treatments for candidosis? (2)
- miconazole cream 2%
| - miconazole 2% + hydrocortisone cream/ointment 1%
72
Name 2 synthetic antifungals
- azoles
| - fluorinated pyrimidines
73
What are the types of polyene? (2)
- nystatin
| - amphotericin B
74
Name a imidazole
Miconazole
75
Name a triazole
Fluconazole
76
What are the indications for nystatin? (4)
- pseudomembranous candidiasis
- erythematous candidiasis
- denture stomatitis
- where fluconazole and miconazole are contraindicated
77
What are the side effects of nystatin? (2)
- oral irritation, sensitisation
| - nausea
78
What are the indications for miconazole? (4)
- pseudomembranous candidosis
- denture stomatitis
- angular chelitis
- oropharyngeal candidiasis
79
What are the adverse reactions of miconazole? (4)
- burning sensation application site
- abdominal pain, diarrhoea
- taste disturbance
- hepatotoxicity
80
What are the adverse reactions of fluconazole? (4)
- headache
- rash
- vomiting
- taste disturbance
81
What is the systemic treatment of candidosis? (4)
- fluconazole capsules 50mg
- fluconazole oral suspension 50mg/5ml
- chlorohexidine gluconate MW
- hypochlorite
82
What is the treatment of denture stomatitis? (4)
- remove denture at night
- soak in hypochlorite or chlorohexidine gluconate
- fluconazole capsules/miconazole oromucusal gel
- if the above contraindicated then nystatin suspension
83
What is the treatment of steroid inhaler related candidosis? (3)
- rinse out mouth and gargle after using steroid inhaler/use spacer
- chlorohexidine gluconate mouthwash
- antifungals
84
What is the treatment of chronic hyper plastic candidosis and median rhomboid glossitis?
Fluconazole
85
What is the treatment of angular cheilitis? (3)
- miconazole cream
- daktakort cream or ointment if unresponsive to miconazole cream
- sodium fusidate ointment
86
Name 4 types of bacterial infections
- staph aureus
- tuberculosis
- syphilus
- ghonnorhea
87
What are the two types of vesiculo- bullous conditions?
```
Intra epithelial (acantholytic and non acantholytic)
Sub epithelial
```
88
Give 4 acantholytic conditions
- pemphigus vulgaris
- pemphigus foliaceous
- paraneoplastic pemphigus
- drug induced pemphigus
89
Name 3 non acantholytic conditions
- herpes simplex
- herpes zoster
- coxsackie infections
90
How do you diagnose pemphigus vulgarise? (2)
- biopsy (conventional tissue or peri lesions biopsy)
| - indirect immunofluorescence
91
What is a conventional tissue biopsy?
Lesional tissue, formalin fixed, H+E stained
92
What is a peri lesions biopsy? (3)
- clinically normal tissue
- frozen
- direct immunofluorescence
93
What is the treatment for intraepithelial vesicullobullous disease? (4)
- immunosuppression (systemic steroids e.g prednisolone)
- DMARD
- biologic (retuximab)
- topical management (benztdamine hydrochloride)
94
Give 4 sub epithelial vesiculobullous diseases? (4)
- erythema multiform
- pemphigoid
- linear IgA
- angina bullosa haemorrhagica
95
What antigens are targeted in mucous membrane pemphigoid? (4)
- BP 180
- BP 230
- a6/B4 integrin sub units
- laminin 332
96
What is the management of sub epithelial mucous membrane pemphigoid? (3)
- analgesic/barrier mouthwash
- topical steroids
- systemic
97
What are the triggers for erythema multiform? (3)
- HSV
- mycoplasma pneumoniae
- medication eg anticonvulsants
98
What is trigeminal neuralgia? (3)
- recurrent unilateral brief electric shock like pains, abrupt in onset and termination
- limited to the distribution of one or more divisions of the trigeminal nerve
- triggered by innocuous stimuli
99
What is classical trigeminal neuralgia?
Trigeminal neuralgia developing without apparent cause other than neurovascular compression
100
What are the pain characteristics of classical trigeminal neuralgia? (4)
- recurring in paroxysmal attacks lasting from a fracture of a second to 2 mins
- severe intensity
- electric shock like, shooting, stabbing or sharp in quality
- precipitated by innocuous stimuli to the affected side of face
101
What is the root entry zone?
The point where the peripheral and central myeline of schwann cells and astrocytes meet
102
What is painful trigeminal neuropathy? (5)
- head and/or facial pain
- in the distribution of one or more branches of the trigeminal nerve
- caused by another disorder
- indicative of neural damage
- pain is highly variable in quality and intensity according to the cause
103
What can painful trigeminal neuropathy be attributed to? (2)
- space occupying lesion
| - multiple sclerosis plaque
104
What is the second line pharmacological treatment for trigeminal neuralgia? (3)
- oxycarbamazepine
- gabapentin
- baclofen, lamotrigine, pimozide
105
What is glossopharyngeal neuralgia? (4)
- severe, transient, stabbing unilateral pain
- experienced in the ear, base of tongue, tonsillar fosaa and/or beneath the angle of the jaw
- provoked by swallowing, talking and/or coughing
- may remit and relapse in the fashion of classical trigeminal neuralgia
106
What are the types of pain in post herpetic neuralgia? (3)
- pain, parasthesia
- background burning/aching pain
- sharp, stabbing pain
107
What is the management of post herpetic neuralgia? (3)
- paracetamol +/- codeine
- amitriptyline
- capsaicin 0.075% cream
108
How do you diagnose giant cell arteritis? (4)
- clinical findings
- c reactive protein
- plasma viscosity
- temporal artery biopsy
109
What is burning mouth syndrome? (3)
- an intraoral burning or dysaesthesia sensation
- recurring daily for more than 2 hours per day over more than 3 months
- without clinically evident causative lesions
110
What are the investigations for burning mouth syndrome?
- FBC
- haematinics
- HbA1c
- TSH
- sialometry
- candidate infection
111
What are the clinical features of persistent idiopathic orofacial pain? (3)
- deep poorly localised
- nagging, burning, gripping, throbbing, pressure
- constant daily pain
112
What are the provoking factors of persistent idiopathic oro facial pain? (5)
- stress
- cold weather
- chewing
- head movements
- life events
113
What are the relieving factors of persistent idiopathic bro facial pain? (3)
- warmth
- pressure
- medication
114
What are the provoking factors of persistent dento alveolar pain disorder? (3)
- hot and cold
- dental treatment
- pressure on tooth
115
What are the associated factors of persistent dento alveolar pain disorder? (4)
- bruxism
- emotional problems
- hypersensitivity to hot and cold
- anxiety or depression
116
What is painful post traumatic trigeminal neuropathy?
Unilateral facial and/or oral pain following trauma to the trigeminal nerve with other symptoms and/or clinical signs of trigeminal nerve dysfunction
117
What are the symptoms of a cluster headache? (4)
- nasal congestion
- conjunctival injection lacrimation
- forehead and facial sweating
- eyelid oedema
118
What radiographic views must you take for mandibular fractures? (4)
- panoramic
- lateral oblique
- PA mandible/facial
- occlusal view
119
What are the open methods of fixation? (4)
- mini plates
- reconstruction plates
- compression plates
- lab screws
120
What are the indications for closed reduction? (4)
- non displaced favourable fractures
- grossly comminuted fractures
- significant loss of overlying soft tissue
- fractures in children
121
What are the disadvantages of closed reduction?(4)
- no absolutely stable
- prolonged period of IMF up to 6 weeks
- possible TMJ sequelae
- decreased oral intake
122
What are the indications for open reduction? (4)
- displaced unfavourable fractures
- multiple fractures
- edentulous displaced fracture
- bilateral displaced condylar fracture
123
What are the advantages of open reduction? (4)
- improved alignment and occlusion
- fracture immobilised
- avoid IMF
- lower rate of infection
124
What is the post operative care after mandibular fractures? (4)
- antibiotics
- steroids
- fluids
- post op X-rays
125
What is the treatment for a fractured condyle? (4)
- soft diet
- analgesics
- open reduction and plating
- closed (leonard buttons and elastic traction)
126
What are the additional signs for a dry mouth? (4)
- evidence of candidosis
- traumatic ulceration
- poor denture retention
- bacterial sialdenitis
127
What are the investigations for diabetes potentially being a cause of dry mouth? (2)
- random blood glucose
| - glycosated haemoglobin
128
What are the extra glandular manifestations of sjogrens syndrome? (4)
- arthritis
- lymphadenopathy
- anaemia
- leukopenia
129
What is the pathology of sjogrens syndrome? (4)
- autoimmune chronic inflammatory condition
- polyclonal b cell proliferation
- acinar atrophy secondary to infiltration by lymphocytes
- exocrine glands
130
What is the proposed new classification for dry mouth inclusion?
- at least one symptom of ocular or oral dryness
- feeling of dry mouth for more than 3 months
- frequently drinks liquids to aid in swallowing dry food
- daily persistent dry eyes for more than 3 months
- recurrent sensation of sand or gravel in eyes
- uses tear substitutes more than 3 times a day
131
What treatment can stimulate saliva? (4)
- sugar free chewing gum
- artificial saliva pastilles
- saliva stimulating tablets
- pilocarpine
132
What treatment can replace saliva? (4)
- carboxymethylcellulose based (glandasone)
- oxidised glycerol triesters (aquaoral)
- mucin based (saliva orthana)
- gels (bioXtra)
133
What drug can cause sialorrhea?
Clozapine
134
What is the presentation of sialadeuosis? (3)
- bilateral
- symmetrical
- diffuse parotid salivary gland enlargement
